AC Patient Encounter PLEASE SEE ATTACHMENT. MAKE SURE TO SEPARATE ALL THE TOPICS. ALSO MAKE SURE REFERENCES ARE PEER REVIEWED ARE DATED FROM 2011 TO PRESENT. Thanks. SEE HER LAB RESULTS below AC Angela Cortez (AC) is a 17-year-old high-school senior who presents for a yearly physical at her mother’s insistence for evaluation of fatigue. The mother, who accompanies her today, notes that AC is “tired all the time.” AC states that this has been going on for several months and, when questioned further, she acknowledges irritability, tearfulness, decline in grades, and lack of enjoyment and participation in her usual activities (track team, choir). AC has had difficulty falling asleep at night. She has gained approximately 15 pounds over the past few months due to poor dietary habits (skips breakfast, late-night eating, French fries two to three times per week), and lack of physical activity.
AC acknowledges that she has been stressed due to her pending college applications, previous break up with her boyfriend, and loss of a valued part-time job. She has been sexually active in the past, but is not currently. She acknowledges infrequent alcohol and marijuana use, but denies substance abuse. She has been spending increasing amounts of time using the Internet, rather than engaging in social activities. AC acknowledges feelings of hopelessness and states that she feels that she “won’t amount to anything” unless she gets a college acceptance and a scholarship, yet she denies any thoughts of hurting herself. Her mother is very concerned about these behaviors. 1. Evaluate lab results to determine the actual and/or potential diseases for which patient is at risk (SEE LAB RESULTS), PLEASE REFER TO UPLOADED GRADING CRITERIA AS WELL.
2. Explain history and physical assessment results that contribute to ACs risk.
3. Cited lab results correlate with the assessment findings to help determine risk Select Tests and Diagnosis Association Expert Feedback
Cushing’s syndrome
cortisol, urine
hypothyroidism
thyroid function tests (TFT)
substance use disorder
drug toxicology testing, urine
attention deficit hyperactivity disorder (ADD/ADHD)
depressive disorder
mononucleosis, Epstein-Barr virus (EBV)
complete blood count (CBC)
heterophile antibody test (mononucleosis spot)
anemia
complete blood count (CBC)
pregnancy
human chorionic gonadotropin (hCG), urine
suicidality
diabetes mellitus type 2
glycated hemoglobin (HbA1c)
glucose, blood (BG)
Test results CBC
Name Value Units Reference Range White blood cells (WBCs) 6045 mm3 4,000-10,000 Red Blood Cell Count (RBC) 4.7 million/l 4.5-5.9(?), 4.0-5.2(?), adults Hemoglobin (Hgb) 13.2 g/dl 14-18(?), 12-16(?), adults Hematocrit (Hct) 40 % 42-54(?), 37-47(?), adults Mean corpuscular volume (MCV) 92 fl 82-103, adults Mean corpuscular hemoglobin (MCH) 30 m3 26-34, adults Mean corpuscular hemoglobin concentration (MCHC) 33 % 30-37, adults Platelets (thrombocytes) 318 k/dL 150-399, adults Red cell distribution width (RDW) 13.9 % 11.5-14.5, adults Neutrophils 61 % 46-78, adult Lymphocytes 32 % 18-52, adult Monocytes 3 % 3-10, adult Eosinophils 1 % 0-6, adult Basophils 3 % 0-3, adult Segmented neutrophils 61 % 36-72, adult Band Cells 0 % 0-6, adult Interpretation: Normal CBD/differential; no evidence of anemia Thyroid function tests (TFT)
Name
Value
Units
Reference Range Thyroid-stimulating hormone (TSH)
1.43
IU/mL
0.35-4.94
Total thyroxine (TT4)
7.9
mg/dL
4.9-11.7
Free thyroxine (FT4)
1.1
ng/dL
0.7-1.5
Total triiodothyronine (TT3)
120
ng/dL
40-210
Free triiodothyronine (FT3)
2.7
pg/dL
1.7-3.7
Free T3 index (FT3I)
130 80-180
Thyroglobulin (Tg)
20
ng/mL
3-40
Interpretation: Normal thyroid function tests (TFT) Heterophile antibody test (mononucleosis spot)
Name
Value
Units
Reference Range Mononucleosis spot (heterophile antibody)
negative Negative (6.7
Interpretation: Normal hemoglobin A1C Cortisol, urine
Name
Value
Units
Reference Range Cortisol, urine
50
g/24hours
10-100 g/24 hours
Interpretation: 24-hour cortisol value is normal Cortisol, urine
50
g/24hours
10-100 g/24 hours
Interpretation: 24-hour cortisol value is normal
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